Drug(s) used | Administration schedule | Expressed wish to end life | No expressed wish to end life | Total | ||
---|---|---|---|---|---|---|
Explicit | Implicit | Patient incapable | Patient capable | |||
Opioid dose no higher than necessary for symptom control, with or without low-dose benzodiazepines | Stable dose over final 3 d | 1 | 1 | 7 | 2 | 11 |
Gradual increase in opioids over final 3 d | 1 | 2 | 8 | 2 | 13 | |
Strong increase in opioids on final day | 2 | 3 | 5 | |||
Opioid doses or sedatives not normally used as part of mainstream palliative care | Opioid doses exceeding symptom requirements, but either stable or gradually increasing, with or without low-dose benzodiazepines | 3 | 1 | 4 | ||
Opioid doses exceeding symptom requirements and strongly rising on last day, with or without low-dose benzodiazepines | 3 | 2 | 6 | 11 | ||
Strong sedatives (barbiturates, propofol or high-dose benzodiazepines) | 3 | 7 | 9 | 1 | 20 | |
Unspecified doses of opioids, benzodiazepines or both | 1 | 1 | 2 | |||
Total | 10 | 13 | 37 | 6 | 66 |
*Reported by the physicians themselves: drugs, doses, opioid course in final 3 days, and whether opioid doses were higher than necessary to relieve symptoms. Judgments of low-dose v. high-dose benzodiazepines were made by the authors: Low-dose benzodiazepines: lorazepam ≤ 2.5 mg; diazepam ≤ 20 mg or no dose indicated; midazolam ≤ 2 mg High-dose benzodiazepines: lorazepam > 2.5 mg; midazolam > 2 mg or no dose indicated.